North by North West: Bill McCarthy's top priorities

Having spent a few months in the post and done the introductory rounds, the new regional director for the north west has come up with some key priorities to make progress on.

Most noteworthy among Bill McCarthy’s five priorities is the strong emphasis placed on meeting constitutional standards, and particularly the four-hour accident and emergency target.

The A&E target is currently subject to a national review, so regulators will be wary of hospitals giving up and pinning their hopes on the arrival of something new.

Because a further nosedive in performance would look pretty terrible, given the (relatively) big uplift in funding for 2019-20. It might even make it more difficult to overhaul the target.

So, while Simon Stevens may have declared it “outdated”, the four-hour standard remains a key barometer of success and a crucial area in which progress needs to be demonstrated in year one of the long-term plan.

This will be particularly relevant for the north west, which has performed dismally on four hours for years, lagging well behind the national average.

Mr McCarthy told a recent meeting of the Greater Manchester Health and Care Board: “These [standards] really matter because from a big process of engagement this is what the citizens of the country told us was part of what they wanted to experience from good health care.

“So, while a four-hour A&E target may look like a kind of capacity and demand monitoring, actually it’s about the experience of millions and millions of people who are feeling vulnerable, worried and unwell, and how we as a public system are able to respond to them.”

Mr McCarthy also cited particular concerns about mental health performance, no doubt with Lancashire near the forefront of his mind.

Anchor institution

His other noteworthy priority was to start thinking about the economic and social impact of health services in local areas, which was a theme introduced in the long-term plan and reinforced by his boss last month.

Blackpool is the classic example of the NHS being an “anchor institution” for the local economy, where it employs around one in five people, but this is also true for several other towns and boroughs in the region.

It will be interesting to see what policies emerge from this thinking, but Mr Stevens seemed to suggest that centralised configurations geared purely at being clinically optimal were no longer what the NHS should aim for.

Mr McCarthy’s other three themes were more routine: to address health inequalities (clearly another big issue for this region), driving up quality and safety, and implementing the long-term plan. Meanwhile, priority areas that go without saying are finance, workforce, and technology.

Line manager

If you’re wondering what Mr McCarthy was doing in Greater Manchester, then you probably missed the news that he now line manages the ‘devolution’ team. He will spend much of his time at NHS England’s offices at Piccadilly Place, where the devolution team are also based, as well as offices in Liverpool and Preston.

While this might make for a slightly awkward atmosphere – as GM was previously unique in reporting straight into NHS England’s national team – Mr McCarthy’s understated approach and strength in partnership-building should make it less so.

Tangible threat

The government’s work to prevent senior doctors being hit with large tax bills on their pension contributions better come up with a solution quickly.

A recent survey of consultants at Salford Royal suggested around 10 per cent had already reduced their contracted hours due to the pension changes, with 70 per cent saying they were considering doing so in the next year.

Around 70 per cent also said they were less likely to undertake additional waiting list initiatives, while around half said they would consider retiring earlier.

In a letter to HSJ, Salford consultants Chris Booth and Simon Tomlinson reckoned this would equate to the loss of around 50 whole time equivalent consultants, representing over 10 per cent of consultant clinical service delivery.

They added: “The results of our survey demonstrate that there is tangible threat to patient safety at our major teaching hospital. We suspect this situation exists across the UK and hope that the evidence we have provided can reinforce the importance of rapid action at a government level in order to avert a crisis in patient care.”